Diagnosis of Lyme disease in late-stage patients is often erroneous. Fallon and colleagues compared Lyme disease test results from four different testing labs, using blood samples from previously diagnosed Lyme patients and healthy controls. Overall, they found variation in results, but no statistically significant difference between labs. However, there was a higher positivity rate for the C6 test, than for whole bacterial sonicate used in the diagnostic test.

Of 1770 children undergoing emergency department evaluation for Lyme disease, 362 (20.5%) children had Lyme disease. Of those with an available tick bite history, only a minority of those with Lyme disease had a recognized tick bite (60/325; 18.5%, 95% confidence interval 14.6-23.0%). Lack of a tick bite history does not reliably exclude Lyme disease.

Published in Science Direct: https://www.sciencedirect.com/science/article/abs/pii/S1877959X18304965?via%3Dihub 
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30853264

Patients with persisting Lyme symptoms were previously found to have higher and more frequent anti-neural antibodies compared to people who were healthy or who had recovered from Lyme disease. Patients with chronic fatigue syndrome (CFS) and persisting Lyme disease often have similar symptoms. This study found that CFS patients do not have elevated anti-neural antibodies. Thus, the common symptoms of persisting Lyme and CFS are not likely due to anti-neural antibodies

The current blood test for Lyme disease has low accuracy. In this study, the authors designed and tested a new blood test that is more accurate. They used portions of proteins, called peptides, from Borrelia burgdorferi, the bacteria that cause Lyme disease. For a patient to be scored as positive, their blood had to contain antibodies that would recognize at least 2 of the 10 bacterial peptides. This test was more sensitive than the current blood test, and could be developed into a newer generation of diagnostic test for Lyme disease.

In Lyme disease endemic areas, initial management of children with arthritis can be challenging because diagnostic tests take several days to return results, leading to potentially unnecessary invasive procedures. Our objective was to examine the role of the C6 peptide enzyme immunoassay (EIA) test to guide initial management.

Published in Pediatrics: https://pediatrics.aappublications.org/content/145/1/e20190593
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31836615

Chronic fatigue syndrome patients and post-treatment Lyme disease patients share some similar neurological symptoms. This study showed that the protein profiles in cerebrospinal fluid from the two groups were distinctive, suggesting that they are two different diseases.

The immune response to B. burgdorferi infection includes the production of antibodies that recognize bacterial surface proteins, one of which is called VlsE. Proteins form complex three-dimensional shapes, and only parts of them, called epitopes, are recognized by antibodies. Alaedini’s group mapped these on VlsE. The antibodies against VlsE differ in patients with later compared to earlier stages of Lyme disease.

Lyme disease patients make antibodies that recognize Borrelia burgdorferi, the bacteria that cause illness. When the disease progresses from early to late stages, these antibodies may change. A protein on the outside of B. burgdorferi is called VlsE, and antibodies that bind to a portion of it called the membrane-proximal domain illustrate this. These specific antibodies were low in patients with early disease, and were increased in patients with symptoms typical of later illness, such as neurological symptoms.

Conventional two-tiered testing (CTTT) for Lyme disease includes a first-tier enzyme immunoassay (EIA) followed by a supplemental immunoblot, and modified two-tiered testing (MTTT) relies on two different sequential EIAs without the inclusion of an immunoblot. MTTT has shown promising results as an alternative strategy for the diagnosis of Lyme disease in adults but has not yet been evaluated in children. We performed a cross-sectional study of children and adolescents ≤21 years of age undergoing clinical investigation for suspected Lyme disease.

Published in Journal of Clinical Microbiology: https://jcm.asm.org/content/57/10/e00547-19
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31413078

The genes that are expressed in sick people differ from those who are healthy. Using advanced sequencing techniques, these researchers found that immune cells in the blood of people with Lyme disease express different genes from those of healthy controls. Genes that are linked to a strong immune response were reduced in Lyme patients compared to those with other bacterial or viral infections. People with persisting symptoms attributed to Lyme disease shared some gene expression patterns with patients suffering chronic illnesses caused by immune system dysfunction.

Published in: Emerg Infect Dis. 2020 Dec; 26(12): 3099–3101.

doi: 10.3201/eid2612.200920

https://pubmed.ncbi.nlm.nih.gov/33219811/

The authors compared the blood of patients suffering more severe symptoms of Lyme disease against those with less. They found that the pattern of chemokines, which are chemical messengers produced by immune cells, varies between the two groups. This work may lead to better diagnostic tools and clinical treatments, and shows a biological difference between these two groups of patients.

The multi-system symptoms accompanying acute and post-treatment Lyme disease syndrome pose a challenge for time-limited assessment. The General Symptom Questionnaire (GSQ-30) was developed to fill the need for a brief patient-reported measure of multi-system symptom burden. In this study we assess the psychometric properties and sensitivity to change of the GSQ-30.

Published in Frontiers in Medicine: https://www.frontiersin.org/articles/10.3389/fmed.2019.00283/full
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31867334

The Lyme PCR is a direct detection test, but has not been rigorously evaluated in children undergoing evaluation for acute Lyme disease.

Published in Vector-Borne and Zoonotic Diseases: https://www.liebertpub.com/doi/10.1089/vbz.2019.2547
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/31821110

Variability in 2-tier Lyme disease test results according to the specific first-tier enzyme immunoassay (EIA) in children has not been examined rigorously. In this study, investigators paired results of clinical 2-tier Lyme disease tests to those of the C6 peptide EIA followed by supplemental immunoblotting (C6 2-tier test).

Published in The Journal of the Pediatric Infectious Diseases Society: https://academic.oup.com/jpids/advance-article-abstract/doi/10.1093/jpids/piy133/5359441?redirectedFrom=fulltext 
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30793167